先天性心脏病婴儿围术期细胞因子表达的变化及1,6-二磷酸果糖对其表达的影响

目的 探讨细胞因子在婴儿先天性心脏病(CHD)围术期的变化及1,6-二磷酸果糖(FDP)对其表达的影响.方法 选择2006年10月-2009年12月在本院心脏病中心接受手术治疗的CHD患儿63例.将63例CHD患儿随机分为试验组(n=30)和对照组(n=33).试验组在体外循环(CPB)前一次性在预充液中加入FDP 200 mg·kg-1,对照组预充液中不加FDP.分别于术前、CPB后3 h和CPB后48 h取血,采用ELISA法检测CHD患儿血清TNF-α、IL-6和IL-8水平.结果 试验组和对照组血清TNF-α、IL-6和IL-8水平术前比较差异均无统计学意义(Pa＞0.05),CPB后3 h,对照组血清TNF-α、IL-6和IL-8水平较试验组显著升高(Pa＜0.05),且2组血清TNF-α、IL-6及IL-8水平均较术前显著升高;CPB后48 h,2组患儿血清TNF-α、IL-6和IL-8水平均比较差异均无统计学意义(Pa＞0.05),但较术前均仍有升高.结论 CHD患儿CPB后3 h血清细胞因子TNF-α、IL-6和IL-8水平明显升高,是导致全身炎性反应的重要因素,在预充液中加入FDP后,可明显减少血清TNF-α、IL-6和IL-8的释放,减轻全身炎性反应.

Changes of Expressions of Cytokines and Effect of Fructose 1,6-Diphosphate on Cytokines during Perioperation of Cardiopulmonary Bypass in Infants with Congenital Heart Disease

Objective To investigate the changes of cytokines during perioperation of cardiopulmonary bypass(CPB) in infants with congenital heart disease(CHD) and effect of fructose 1,6-diphosphate(FDP)on the cytokines expression.Methods Sixty-three infants with CHD who were hospitalized in Heart Center of Children′s Hospital of Jiangxi Province were selected and they were randomly divided into treatment group(n=30) and control group(n=33),FDP(200 mg·kg-1)was added into the prime fluid before CPB in treatment group but FDP was not added in control group.Blood samples were drawn at 3 time points: before CPB,3 h after CPB and 48 h after CPB.The concentration of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and IL-8 in plasma were measured by enzyme-linked immunosorbent assay.Results The concentration of TNF-α,IL-6 and IL-8 between the 2 groups showed no significant difference before CPB and 48 h after CPB(Pa>0.05),but they had significant differences between both groups at 3 h after CPB(Pa<0.05).At 3 h after CPB and 48 h after CPB,the concertration of TNF-α,IL-6 and IL-8 in both groups were higher than those before CPB.Conclusions The concentration of cytokines are significantly elevated after CPB which is the important factor resulting in systemic inflammatory response.FDP can reduce the concentration of TNF-α,IL-6 and IL-8 in plasma after CPB.FDP may alleviate the systemic inflammatory at after CPB and 48 h after CPB.